Treatment Drift
As a consultant, this is sometimes the hardest thing to deal with once a young adult enrolls in their treatment program. Although I do my best trying to make sure that I frontload all the “what to expects” to parents, and do the same for the program with my experiences with the young adult and family - sometimes we get pulled in a different direction once the treatment process has started. This is what I refer to as going “off course.”
Let’s stick with this obnoxious navigating metaphor sequence, shall we? When I am making recommendations for treatment for the young adult and family, we are all on the same (map) page and understand the course for treatment. We see the horizon line off the distance, and understand we will have to weather some storms along the way, but for today - the seas may seem calm. There is hope in getting to the final destination. When I have a young adult that is all-in and doing the work and making changes, sometimes that’s when I start to see the parents struggle. Change is hard, right? We want it, until we feel how it impacts us and then we sometimes respond in sabotaging ways that cause “treatment drift.”
This article isn’t meant to be a vague story of navigating the treatment journey, but rather being very specific to what “treatment drift” can sometimes look like. Mind you, this typically starts to rear it’s ugly head about 2-3 months into the treatment journey. The young adult is “in it” and the parents really start to question everything. Their alignment with the treatment teams wains and then they start to demand more from the team. This, in turn, takes the team away from directly working with the young adult and instead takes a massive amount of energy and effort to help to get the parents “back on course.” Here are some very common examples I get from parents, that individually are never an issue, but when lumped together become a growing program. I get some serious push-back from parents in trusting a program and wanting to continue to pay for treatment when they start to collectively notice and make note of some of the following:
Staff traveling for personal or professional reasons. You need to anticipate this happening at least once while your child is in their care. It has nothing to do with your child, and it’s not going to negatively impact your child’s treatment journey either. You want these staff to have personal breaks to ensure they’re mentally well themselves. You always want them traveling for trainings or conferences because you want them to have their own continued education.
Sometimes things come up (like in a mental health treatment facility, this happens often!), so staff might need to ask to reschedule their calls with you. It’s not meant to be an inconvenience to you. Most parents I work with love consistency and keeping a standing weekly call. Just know sometimes, this might have to be shifted.
Accidents or inconveniences happen, and it’s never meant to be intentional (unless the program tells you otherwise and it was a therapeutic litmus test). Example: Your child is supposed to go to the grocery store, but because there were too many people who needed to go - there wasn’t space in the van for your child. They weren’t able to go to the grocery store until later that day.
Programs do get new staff, and sometimes staff leave (or get fired). Sometimes parents are alerted of this information, but most of the time they aren’t. It’s not important to be informed of this information unless it was a tragic situation, or impacted your child. These are reasons to be informed. This is a program’s worst fear to have your child impacted by traumatic staffing changes. If you don’t hear about it, you can assume it’s not important enough for you to know about.
If your child somehow communicates with you outside of the typical staff channels (i.e. letter writing through the therapist), you need to tell the staff. If you don’t, you’re keeping a secret. It’s not about protecting your child. It’s about protecting the quality of the treatment program and ensuring that there are no dangerous situations between clients that are being created without staff being aware. If someone is motivated to get connected to their parents outside of the typical lines of communication, they will make it happen. It’s just important that parents relay any communication then to the program.
Young adults will walk away from a program - whether it’s drug-seeking or needing to go to a hospital. You cannot assume that just because you found an amazing program that the participants there aren’t struggling with their substance use and mental health. I’m always stunned when parents say “how could the staff just let them walk out?!” Well, as you can imagine someone who is motivated and in active addiction - they will do what they need to go to feed that addiction. No program is locked (unless it’s a locked psychiatric hospital), so a young adult can walk at any point. Be understanding to the fact that other participants in the program won’t have a linear treatment process, just like your child probably won’t either. The important piece to this is “if they walk out, do they then walk back to the program?'“ If yes, that’s progress.
Just because you pay for treatment for a loved one does not make you are a staff member. You are not involved in all the nuances of running a program. If a program doesn’t give parents a daily or weekly schedule, it’s most-likely because they are trying to help you individuate and not hyper-focus on your own child’s schedule while in treatment. Take care of yourself, and that involves not being in-the-know of where you child is on an hourly basis. You don’t need to know where they are at all times while they’re in treatment. You know they are there, unless the program tells you otherwise. There’s nothing worse than a parent that demands to be in-the-know because they’re paying for treatment. Be mindful that this level of demand will warrant a reconsideration of your child being in their treatment program.
There are probably a lot more prime examples I could write, but the above are the most common that come top-of-mind. When you start to ask more questions, second guessing the treatment program and consider pulling your young adult out of treatment early, a program will not be able to make strides with your child. Without realizing it, you have become the identified priority family member needing treatment - not your young adult. And to really seal the deal, if you do pull them before the average length of treatment stay, you can bet that your child will not have made the significant improvements you were hoping to see. That’s the fastest way to be resentful for paying for treatment where you don’t see the long-term benefits of that investment. Not ideal.
And lastly, I’ll reiterate that a program ultimately has the say in the end if you, as the parent, are demanding more time of their staff than the young adult. When those scales are tipped, then sometimes the program needs to make an executive decision to discharge your family. Note that it doesn’t say discharge the young adult because they know that they can still work with them, but the parents have created the drift from the original treatment plan. When the parents become too much, a program can set sail without you. Don’t let yourself - your anxiety mostly - get in the way of your loved ones treatment.
For questions or comments contact Joanna.
